Provider Demographics
NPI:1821009655
Name:KAK, VIVEK (MD)
Entity Type:Individual
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First Name:VIVEK
Middle Name:
Last Name:KAK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-788-4781
Mailing Address - Fax:517-788-4799
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-788-4781
Practice Address - Fax:517-788-4799
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301073071207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4798503-10Medicaid
MIP21340001Medicare ID - Type Unspecified
H40604Medicare UPIN